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Nguyen HTH, Nguyen OTK, Tran TN, Nguyen AC, Liamputtong P, Bui LK. The impacts of cancer treatment on lifestyle habits and mental health in Vietnamese women: an exploratory qualitative study. Support Care Cancer 2024; 32:654. [PMID: 39259391 DOI: 10.1007/s00520-024-08831-6] [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: 11/02/2023] [Accepted: 08/22/2024] [Indexed: 09/13/2024]
Abstract
AIMS This qualitative study explores the experiences of women after cancer treatment in terms of habit changes and mental health impact. METHOD The study involved 10 women who had undergone cancer treatment, recruited from three major hospitals in Hanoi, Vietnam. Data were collected through semi-structured interviews, which were transcribed and analyzed using thematic analysis. RESULTS The findings of the study shed light on the various factors influencing lifestyle behavior and mental health changes among women after cancer treatment. Ten participants, aged 39 to 64 years, shared experiences including dietary changes, sleep disruptions, and reliance on non-scientific sources for health decisions. Initially shocked by their diagnosis, many transitioned to acceptance, adopting a "giving-in" attitude. Cultural beliefs, word-of-mouth sharing, and social support networks played significant roles in shaping post-treatment lifestyle changes, coping mechanisms, information-seeking behaviors, and mental health. CONCLUSION The study highlights the need for accessible and scientifically verified information for women after cancer treatment to make informed decisions about their health. It emphasizes the importance of addressing traditional beliefs and promoting evidence-based practices. Moreover, the study underscores the importance of social support and relationships in coping with the challenges of post-cancer experiences.
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Affiliation(s)
- Huyen Thi Hoa Nguyen
- College of Health Sciences, VinUniversity, Hanoi, Vietnam.
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | | | - Tran Ngoc Tran
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
| | | | - Pranee Liamputtong
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linh Khanh Bui
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Kingsberg S, Banks V, Caetano C, Janssenswillen C, Moeller C, Schoof N, Lee L, Scott M, Nappi RE. Real-world clinical evaluation of natural and induced vasomotor symptoms in the USA and Europe. Climacteric 2024; 27:364-372. [PMID: 38695491 DOI: 10.1080/13697137.2024.2340472] [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: 12/20/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE This study aimed to examine physicians' and patients' perceptions regarding symptom burden and impact in women experiencing natural vasomotor symptoms (nVMS) or vasomotor symptoms induced by endocrine therapy for breast cancer (iVMS). METHODS The cross-sectional survey based on real-world clinical consultations was conducted in the USA and five European countries. Obstetrician-gynecologists, primary-care physicians and oncologists provided demographic and symptom data for patients experiencing VMS; patients optionally self-reported their experiences via questionnaires, including their symptom profile and work/activity burden through the Menopause Quality of Life (MENQOL) and Work Productivity and Activity Impairment (WPAI) tools. RESULTS Physicians completed survey forms on 2451 consulting patients; patients completed 1029 questionnaires. nVMS and iVMS severity was significantly associated with the severity of mood symptoms and sleep disturbances (p < 0.0001). However, around half of the patients with mild nVMS/iVMS also experienced moderate-severe mood changes (55.4%/43.7%) or sleep disturbances (42.4%/40.4%). Presence of mood/sleep disturbances alongside nVMS increased MENQOL vasomotor scores (p = 0.004/p < 0.001). Presence of sleep disturbances increased WPAI activity impairment (p < 0.001) but mood changes did not. Similar findings were reported for iVMS patients. CONCLUSION Significant burden from the triad of natural or induced menopausal symptoms, sleep disturbances and mood changes affected women's daily activities, work and quality of life more than vasomotor symptoms alone.
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Affiliation(s)
- Sheryl Kingsberg
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Victoria Banks
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Reading, UK
| | - Cecilia Caetano
- Medical Affairs Women's Healthcare, Bayer Consumer Care, Basel, Switzerland
| | | | - Carsten Moeller
- IEG TA WHC, Immunology, Inflammation, Bayer AG, Berlin, Germany
| | - Nils Schoof
- IEG TA WHC, Immunology, Inflammation, Bayer AG, Berlin, Germany
| | - Lauren Lee
- Respiratory & Women's Health, Adelphi Real World, Bollington, UK
| | - Megan Scott
- Respiratory & Women's Health, Adelphi Real World, Bollington, UK
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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Henze M, Stuckey BGA. Endocrine consequences of breast cancer therapy and survivorship. Climacteric 2024; 27:333-339. [PMID: 38867405 DOI: 10.1080/13697137.2024.2354725] [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: 01/18/2024] [Revised: 04/01/2024] [Accepted: 04/28/2024] [Indexed: 06/14/2024]
Abstract
Breast cancer survivorship is increasing, due to earlier diagnosis of the disease and more effective therapies. Long-term endocrine sequelae, including early menopause, bone health, fertility implications and menopausal symptoms, are important survivorship issues. Ovarian failure is common with chemotherapy and options for preserving fertility in young women include ovarian suppression during chemotherapy and oocyte or embryo cryopreservation before chemotherapy. Tamoxifen as adjunct therapy in premenopausal women leads to ovarian stimulation, sometimes ovulation and occasionally pregnancy with important teratogenic implications. Aromatase inhibitor therapy with or without gonadotrophin releasing hormone (GnRH) agonist leads to profound bone loss and anti-resorptive therapy is advised to prevent fracture. Tamoxifen acts to preserve bone in postmenopausal women but not premenopausal women. Pregnancy is not discouraged in young women with early breast cancer, even to the point of pausing adjunct therapy in order to conceive. However, menopausal hormone therapy is discouraged even years later. Non-hormonal therapy for menopausal symptoms in breast cancer survivors is available but, in some cases, estrogen-containing therapy may be worthy of consideration for quality of life in the informed patient.
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Affiliation(s)
- Meg Henze
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Bronwyn G A Stuckey
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Keogh Institute for Medical Research, Nedlands, WA, Australia
- Medical School, University of Western Australia, Nedlands, WA, Australia
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van der Hoef C, Bawuah Dsane L, Schuur N, Louwers YV, Mens JW, Hikary-Bhal N, van Doorn HC. Hormone replacement therapy in women with iatrogenic premature ovarian insufficiency after radiotherapy for cervical cancer: A retrospective cohort and survey study. Maturitas 2024; 185:108004. [PMID: 38663162 DOI: 10.1016/j.maturitas.2024.108004] [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: 10/28/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES This study assessed the uptake of hormone replacement therapy (HRT) in cervical cancer patients with iatrogenic menopause. Survival in relation to HRT use was assessed via a retrospective chart study, and the severity of menopausal symptoms, motivations and barriers to starting HRT were examined via questionnaires. STUDY DESIGN In total, 293 women under the age of 51 and treated with radiotherapy for cervical cancer between 2010 and 2020 were identified. Medical records were searched for information on HRT use. If still living, women were sent digital questionnaires addressing menopausal symptoms, quality of life (QoL) and potential barriers and motivations concerning HRT use. Univariable data were analysed using Mann-Whitney U, chi-square, and Fisher's exact test, while logistical regression was used to analyse relationships between certain variables and use of HRT and survival. RESULTS Overall HRT uptake was 78.1 %, which was related to age and Charlson Comorbidity Index, but independent of the duration of radiotherapy or FIGO stage. Overall survival was higher for HRT users (χ2(1) = 4.3, p = 0.038). Questionnaires were sent to 193 patients and 100 completed it (response rate 51.8 %). Main reasons for HRT use were relief of hot flushes and improvement in QoL. For women below age 51, QoL was indeed higher for current HRT users than for non-HRT users (EQ-index 0.8 vs. 0.7, p = 0.008). CONCLUSIONS HRT prescription rate was inversely correlated with age. Survival was not negatively affected by HRT use. It is important to stress the benefits of HRT and address women's fears regarding its use.
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Affiliation(s)
- Charlotte van der Hoef
- Department of Gynaecologic Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Lawrencia Bawuah Dsane
- Department of Gynaecologic Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | - Nicoline Schuur
- Department of Gynaecologic Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | - Yvonne V Louwers
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, ErasmusMC, University Medical Center Rotterdam, the Netherlands.
| | - Jan Willem Mens
- Department of Radiation Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | | | - Helena C van Doorn
- Department of Gynaecologic Oncology, ErasmusMC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
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Palaia I, Caruso G, Di Donato V, Turetta C, Savarese A, Perniola G, Gallo R, Giannini A, Salutari V, Bogani G, Tomao F, Giannarelli D, Gentile G, Musella A, Muzii L, Pignata S. Hormone replacement therapy in gynecological cancer survivors and BRCA mutation carriers: a MITO group survey. J Gynecol Oncol 2024; 35:e70. [PMID: 38497108 PMCID: PMC11107284 DOI: 10.3802/jgo.2024.35.e70] [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: 01/16/2023] [Revised: 06/16/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE Early iatrogenic menopause in gynecological cancer survivors and BRCA mutation (BRCAm) carriers undergoing risk-reducing salpingo-oophorectomy (RRSO) is a major health concern. Hormone replacement therapy (HRT) is the most effective remedy, but remains underused in clinical practice. The Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group promoted a national survey to investigate the knowledge and attitudes of healthcare professionals regarding the prescription of HRT. METHODS The survey consisted of a self-administered, multiple-choice 45-item questionnaire, available online to all MITO members for 2 months starting from January 2022. RESULTS A total of 61 participants completed the questionnaire (47 out of 180 MITO centers; compliance: 26.1%). Most respondents were female (73.8%), younger than 50 years (65.6%), and gynecologic oncologists (55.7%), working in public general hospitals (49.2%). An 84.4% of specialists actively discuss HRT with patients and 51.0% of patients ask the specialist for an opinion on HRT. The rate of specialists globally in favor of prescribing HRT was 22.9% for ovarian cancer, 49.1% for cervical cancer, and 8.2% for endometrial cancer patients. Most respondents (70.5%) believe HRT is safe for BRCA-mutated patients after RRSO. Nearly 70% of physicians prescribe systemic HRT, while 23.8% prefer local HRT. Most specialists recommend HRT for as long as there is a benefit and generally for up to 5 years. CONCLUSION Real-world data suggest that many healthcare professionals still do not easily prescribe HRT for gynecological cancer survivors and BRCA mutation carriers after RRSO. Further efforts are required to implement the use of HRT in clinical practice and to support both clinicians in recommending HRT and patients in accepting it.
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Affiliation(s)
- Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Camilla Turetta
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Savarese
- Department of Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberta Gallo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Vanda Salutari
- Division of Gynecologic Oncology, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Diana Giannarelli
- Biostatistic Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriella Gentile
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Angela Musella
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
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Hickey M, Basu P, Sassarini J, Stegmann ME, Weiderpass E, Nakawala Chilowa K, Yip CH, Partridge AH, Brennan DJ. Managing menopause after cancer. Lancet 2024; 403:984-996. [PMID: 38458217 DOI: 10.1016/s0140-6736(23)02802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/18/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Jenifer Sassarini
- Department of Obstetrics and Gynaecology, School of Gynaecology, University of Glasgow, Glasgow, UK
| | - Mariken E Stegmann
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donal J Brennan
- Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland; Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
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Zhao D, Ma Q, Li G, Qin R, Meng Y, Li P. Treatment-induced menopause symptoms among women with breast cancer undergoing chemotherapy in China: a comparison to age- and menopause status-matched controls. Menopause 2024; 31:145-153. [PMID: 38086004 DOI: 10.1097/gme.0000000000002296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Whether women with breast cancer experience more severe menopause symptoms than comparison women without a history of breast cancer diagnosis remains unclear. We aimed to investigate whether women with breast cancer undergoing chemotherapy experience more severe menopause symptoms than comparison women and explore various factors influencing menopause symptoms in women with breast cancer undergoing chemotherapy. METHODS This cross-sectional observational study recruited 423 women with breast cancer undergoing chemotherapy and 1,829 community women without breast cancer. All participants completed a questionnaire assessing menopause symptoms using the Menopause Rating Scale and general characteristics (eg, sociodemographic and clinical data). Propensity score matching was used to reduce the confounders between the two groups. Student's t test or Mann-Whitney U test and chi-square tests were used to compare the differences in menopause symptoms between the two groups. Multivariate linear regression analysis was performed to explore various factors influencing menopause symptoms in women with breast cancer undergoing chemotherapy. RESULTS After propensity score matching, 808 participants were included. The mean ages of women with breast cancer undergoing chemotherapy and comparison women were 49.58 and 49.10 years, respectively. Women with breast cancer undergoing chemotherapy experienced significantly more severe vasomotor symptoms than comparison women. However, comparison women had higher Menopause Rating Scale scores and more severe menopause symptoms than women with breast cancer undergoing chemotherapy. Age, occupational status, chemotherapy-induced amenorrhea, family history of cancer, chemotherapy stage, mindfulness, resiliency, and illness perception were associated with menopause symptoms in women with breast cancer undergoing chemotherapy. CONCLUSIONS Vasomotor symptoms are prominent among women with breast cancer undergoing chemotherapy. Understanding the factors contributing to menopause symptoms is crucial for healthcare practitioners to develop supportive guidelines for the well-being of women with breast cancer undergoing chemotherapy.
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Affiliation(s)
- Di Zhao
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Qinghua Ma
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guopeng Li
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Rui Qin
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Yingtao Meng
- Nursing Department, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ping Li
- From the School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
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Singh K, Ireson J, Rollins S, Gillett S, Ronksley J, Winter MC. Patients' experience of menopausal symptoms post-chemotherapy treatment for gestational trophoblastic neoplasia. Eur J Oncol Nurs 2024; 68:102481. [PMID: 38043171 DOI: 10.1016/j.ejon.2023.102481] [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: 08/04/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE We aimed to explore patient's experience of chemotherapy-induced menopausal symptoms; to ascertain how patients tried to alleviate their symptoms and how health professionals supported them in order to identify current unmet needs. METHODS We designed a retrospective cross-sectional exploratory study of a sample of 11 women who received multi-agent combination chemotherapy for Gestational Trophoblastic Neoplasia. Postal surveys using the Greene Climacteric Scale (GCS) questionnaire followed up by semi-structured telephone interviews were used. Framework analysis technique was used to generate descriptions of patient's experiences. RESULTS Symptoms of feeling tired or lacking in energy, loss of interest in sex, muscle and joint pains and difficulty in concentrating affected participants the most. The menopausal symptoms appear to be temporary; symptoms such as hot flushes and night sweats seem to subside with resumption of menses. Others are more gradual with some evidence that mental health takes longer to recover. Regarding potential symptoms, some women do not retain the information given to them at discharge following end of treatment, which GTD services need to take into consideration when supporting patients. CONCLUSION Patients need to be more optimally prepared for post-chemotherapy recovery with each patient's needs and support being individually tailored. How information is discussed and disseminated needs improving to ensure patients retain the information they receive at discharge. Recommendations include the creation of menopause information booklet, alongside further developing virtual nurse-led follow up clinics post chemotherapy.
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Affiliation(s)
- Kam Singh
- Sheffield Trophoblastic Disease Centre, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, South Yorkshire, United Kingdom.
| | - Jane Ireson
- Sheffield Trophoblastic Disease Centre, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, South Yorkshire, United Kingdom
| | - Sarah Rollins
- Sheffield Trophoblastic Disease Centre, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, South Yorkshire, United Kingdom
| | - Sarah Gillett
- Sheffield Trophoblastic Disease Centre, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, South Yorkshire, United Kingdom
| | - Joanna Ronksley
- Sheffield Trophoblastic Disease Centre, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, South Yorkshire, United Kingdom
| | - Matthew C Winter
- Sheffield Trophoblastic Disease Centre, Weston Park Hospital, Whitham Road, Sheffield, S10 2SJ, South Yorkshire, United Kingdom
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Serquiz N, Sarmento ACA, Almeida NR, Nobre ML, Medeiros KS, Oliveira RD, Costa APF, Gonçalves AK. Laser and radiofrequency for treating genitourinary syndrome of menopause in breast cancer survivors: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e075841. [PMID: 37949628 PMCID: PMC10649472 DOI: 10.1136/bmjopen-2023-075841] [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] [Received: 05/19/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Breast cancer survivors (BCSs) experience more severe symptoms of genitourinary syndrome of menopause (GSM) than healthy postmenopausal women. As hormonal therapy with oestrogen should be avoided in BCSs, finding an effective and safe therapy to address vaginal symptoms and sexual dysfunction is urgently needed. Physical methods may be promising alternatives for the specificities of this group of women. This review aims to evaluate the efficacy and safety of physical methods (laser and radiofrequency) for treating GSM in BCSs. METHODS AND ANALYSIS The PubMed, Embase, Web of Science, SciELO, LILACS, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases will be searched. A search strategy was developed to retrieve clinical trials that evaluate the efficacy and safety of any physical method (laser or radiofrequency) used for GSM in BCSs. No date or language restrictions will be imposed. Two authors will independently select studies by title, abstract and full text to meet the inclusion criteria. Data will be extracted, and the risk of bias will be evaluated using the Cochrane risk-of-bias tool (RoB 2). Review Manager 5.4.1 will be used for data synthesis. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess the strength of the evidence. ETHICS AND DISSEMINATION This study reviews the published data; thus, obtaining ethical approval is unnecessary. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023387680.
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Affiliation(s)
- Nicoli Serquiz
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Obstetrics and Gynecology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ayane Cristine Alves Sarmento
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Natalie Rios Almeida
- Postgraduate Program student in Obstetrics and Gynecology, UNICAMP, Campinas, Brazil
| | - Maria Luisa Nobre
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Surgery, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Ronnier de Oliveira
- Graduate medical student, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana Paula Ferreira Costa
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Institute of Teaching, Research and Innovation, League Against Cancer, Natal, Brazil
| | - Ana Katherine Gonçalves
- Postgraduate Program student in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Obstetrics and Gynecology, Federal University of Rio Grande do Norte, Natal, Brazil
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Lubián-López DM, Butrón-Hinojo CA, Menjón-Beltrán S, González-Mesa E, Tapiador-Albertos S, Rodríguez-Jiménez B, Fiol-Ruiz G. Effects of Non-Ablative Solid-State Vaginal Laser (SSVL) for the Treatment of Vulvovaginal Atrophy in Breast Cancer Survivors after Adjuvant Aromatase Inhibitor Therapy: Preliminary Results. J Clin Med 2023; 12:5669. [PMID: 37685736 PMCID: PMC10488849 DOI: 10.3390/jcm12175669] [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: 05/14/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND One of the side effects of anti-estrogen treatments in breast cancer survivors (BCSs), especially with aromatase inhibitor (AI) treatment, is the frequent appearance of vulvo-vaginal atrophy (VVA). We aim to evaluate the efficacy, safety and feasibility of a new type of non-ablative Solid-State Vaginal Laser (SSVL) treatment in BCSs with VVA. METHODS A total of 30 BCSs with a history of AI use and symptoms of VVA were treated with a non-ablative SSVL (LASEmaR 1500™-EUFOTON)in this non-randomized pilot study. The effects of the laser have been evaluated at baseline, 10 wk and 24 wk using a visual analogue scale (VAS), the Vaginal Health Index (VHI), the Vulvar Health Index (VuHI), the Female Sexual Function Index (FSFI), the EORTC QLQ-BR23, the Vaginal Maturation Index (VMI) and vaginal pH. RESULTS At 10-week follow-up vs. baseline there were no statistically significant differences in FSFI, lubrication and EORTC QLQ-BR23. In all the subjective (dyspareunia, VHI, VuHI, FSFI, QLQ) and objective parameters (VMI and pH) there was a statistically significant improvement at the 6-month follow-up. Satisfaction was very high (4.7 out of 5), with 95.7% of patients being satisfied, more than or very satisfied. CONCLUSIONS Preliminary results of SSVL treatment of VVA and dyspareunia in BCSs after AI treatment suggest clinical improvement, without relevant side effects and with a high degree of satisfaction.
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Affiliation(s)
- Daniel M. Lubián-López
- Department of Obstetrics and Gynecology, University Hospital of Jerez de la Frontera, 11407 Cádiz, Spain;
- Department of Obstetrics and Gynecology, Viamed Bahía de Cádiz Hospital, 11130 Cádiz, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Cádiz, 11003 Cádiz, Spain
| | - Carmen A. Butrón-Hinojo
- Department of Obstetrics and Gynecology, University Hospital of Jerez de la Frontera, 11407 Cádiz, Spain;
- Department of Obstetrics and Gynecology, Viamed Bahía de Cádiz Hospital, 11130 Cádiz, Spain
| | - Salomón Menjón-Beltrán
- Department of Obstetrics and Gynecology, Regional University Hospital of Granada and Inagor Women’s Clinic, 18001 Granada, Spain;
| | - Ernesto González-Mesa
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29001 Málaga, Spain;
| | - Silvia Tapiador-Albertos
- Department of Obstetrics and Gynecology, Alboran CMM Women’s Clinic, 04001 Almería, Spain; (S.T.-A.); (B.R.-J.); (G.F.-R.)
| | - Bibiana Rodríguez-Jiménez
- Department of Obstetrics and Gynecology, Alboran CMM Women’s Clinic, 04001 Almería, Spain; (S.T.-A.); (B.R.-J.); (G.F.-R.)
| | - Gabriel Fiol-Ruiz
- Department of Obstetrics and Gynecology, Alboran CMM Women’s Clinic, 04001 Almería, Spain; (S.T.-A.); (B.R.-J.); (G.F.-R.)
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11
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Sheng Y, Carpenter JS, Smith BJ, Paul SM, Melisko M, Moslehi J, Levine JD, Conley YP, Kober KM, Miaskowski C. A Pilot Study of Associations Between the Occurrence of Palpitations and Cytokine Gene Variations in Women Prior to Breast Cancer Surgery. Biol Res Nurs 2023; 25:289-299. [PMID: 36255356 PMCID: PMC10236444 DOI: 10.1177/10998004221134684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Palpitations are common and have a negative impact on women's quality of life. While evidence suggests that inflammatory mechanisms may play a role in the development of palpitations, no studies have evaluated for this association in patients with breast cancer who report palpitations prior to surgery. The purpose of this pilot study was to evaluate for associations between the occurrence of palpitations and single nucleotide polymorphisms (SNPs) in genes for pro- and anti-inflammatory cytokines, their receptors, and transcriptional regulators. METHODS Patients were recruited prior to surgery and completed a self-report questionnaire on the occurrence of palpitations. Genotyping of SNPs in cytokine genes was performed using a custom array. Multiple logistic regression analyses were done to identify associations between the occurrence of palpitations and SNPs in fifteen candidate genes. RESULTS Of the 82 SNPs evaluated in the bivariate analyses, eleven SNPs in 6 genes were associated with the occurrence of palpitations. After controlling for functional status, the occurrence of back pain, and self-reported and genomic estimates of race/ethnicity, 3 SNPs in 3 different genes (i.e., interleukin (IL) 1-beta (IL1B) rs1143643, IL10 rs3024505, IL13 rs1295686) were associated with the occurrence of palpitations prior to surgery (all p ≤ .038). CONCLUSIONS While these preliminary findings warrant replication, they suggest that inflammatory mechanisms may contribute to the subjective sensation of palpitations in women prior to breast cancer surgery.
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Affiliation(s)
- Ying Sheng
- School of Nursing, Vanderbilt University,
Nashville, TN, USA
| | | | - Brenda J. Smith
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Steven M. Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Michelle Melisko
- School of Nursing, University of California, San Francisco, CA, USA
| | - Javid Moslehi
- School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D. Levine
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA, USA
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12
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Avis NE, Crawford SL, Gold EB, Greendale GA. Sexual functioning among breast cancer survivors and non-cancer controls over 5 years post diagnosis: Pink SWAN. Cancer Med 2023; 12:7356-7368. [PMID: 36440508 PMCID: PMC10067058 DOI: 10.1002/cam4.5433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare sexual functioning from diagnosis to 5 years post diagnosis among breast cancer survivors (BCS) and women without cancer (controls). PATIENTS AND METHODS Analyses included 118 BCS and 1765 controls from 20 years of the longitudinal Study of Women's Health Across the Nation (SWAN), a multiracial/ethnic cohort of mid-life women assessed approximately annually from 1995 to 2015. Pink SWAN participants reported no cancer at SWAN enrollment and developed (BCS) or did not develop (controls) incident breast cancer after enrollment. Outcomes included: being sexually active or not, intercourse frequency, sexual desire, vaginal dryness, and pain with intercourse. Using longitudinal logistic regression, we compared BCS and controls on prevalence of sexual functioning outcomes with respect to years since diagnosis. In addition, we examined whether menopause transition stage, depressive symptoms, relationship satisfaction, vaginal dryness, or pain with intercourse modified the relation between breast cancer and sexual functioning outcomes. RESULTS Adjusting for partner status, both BCS and controls reported similar declines over time in being sexually active, sexual intercourse frequency, and sexual desire. Among sexually active women, more BCS than controls consistently reported vaginal dryness with significant differences between 2 and 4 years post-diagnosis, and pain with intercourse, with statistically significant differences between 0.5 years post-diagnosis to 2 years post-diagnosis. Being post-menopausal and reporting depressive symptoms were significant effect modifiers for pain with intercourse with both variables having positive and stronger associations with pain among the controls than among BCS. CONCLUSION Except for more reporting of vaginal dryness and pain with intercourse among BCS, negative changes in sexual function during mid-life were similar in those with and without breast cancer.
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Affiliation(s)
- Nancy E. Avis
- Department of Social Sciences & Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Sybil L. Crawford
- Tan Chingfen Graduate School of NursingUMass Chan Medical SchoolWorcesterMassachusettsUSA
| | - Ellen B. Gold
- Department of Public Health SciencesSchool of Medicine, University of CaliforniaDavisCaliforniaUSA
| | - Gail A. Greendale
- David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
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13
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Rachagan N, Szabo RA, Rio I, Rees F, Hiscock HM, Hickey M. Video telehealth to manage menopausal symptoms after cancer: a prospective study of clinicians and patient satisfaction. Menopause 2023; 30:143-148. [PMID: 36696638 DOI: 10.1097/gme.0000000000002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate clinician and patient satisfaction with a novel video conferencing telehealth (VCT) service and barriers to use. METHODS A prospective observational study (2018-2020) of a statewide VCT service using healthdirect was performed. Participants were clinicians and patients from the Menopausal Symptoms After Cancer service. Patients were cancer survivors aged 20 to 70 years referred to the Menopausal Symptoms After Cancer service to manage early menopause/menopausal symptoms or women at high inherited risk of cancer due to pathogenic gene variants, such as BRCA1/2 between September 2018 and May 2020. Data were analyzed descriptively. The main outcome measures for clinicians were clinician satisfaction and ease of use, duration of consultation, patient rapport and standard of care, and future intention to use VCT. Outcome measures for patients were reasons for choosing telehealth, preferred devices, ease of use, perceived benefits and standard of care, and future intention to use VCT. RESULTS Data were available from 109 complete clinician surveys. Overall satisfaction was high (93%), but 32% reported technical difficulties and 42% found VCT distracting. Most reported that standard of care (91%), consultation duration (93%), and patient rapport (73%) were unaffected and 97% would use VCT again for patients not requiring examination. From 35 complete patient surveys, saving travel time and cost were the main reasons for choosing VCT (57%) and for convenience (31%). Most found the platform easy to use (83%) and were comfortable with the technology (83%) without technical difficulties (89%). All found the platform easier and less time consuming than in-person appointments. Most believed that the standard of care received was equivalent to an in-person consultation (94%), were satisfied with the consultation (97%), and would choose VCT again (97%). CONCLUSIONS Clinician and patient satisfaction with VCT was high and clinical standards were maintained. However, technical difficulties and distractions were common for clinicians despite training.
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Affiliation(s)
| | | | - Ines Rio
- Royal Women's Hospital, Melbourne, VIC, Australia
| | - Faith Rees
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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14
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Suzuki Y, Huang Y, Ferris J, Kulkarni A, Hershman D, Wright JD. Prescription of hormone replacement therapy among cervical cancer patients with treatment-induced premature menopause. Int J Gynecol Cancer 2023; 33:26-34. [PMID: 36543392 DOI: 10.1136/ijgc-2022-003861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the utilization of hormone replacement therapy (HRT) among newly diagnosed cervical cancer patients who experienced premature menopause due to primary treatment. METHODS The MarketScan Databases were used to identify newly diagnosed cervical cancer patients <50 years of age with premature menopause after hysterectomy with bilateral salpingo-oophorectomy (primary surgery) or primary external beam pelvic radiation (primary radiotherapy). We examined the cumulative utilization of HRT until 24 months after the loss of ovarian function. Fine-Gray subdistribution hazard models were developed to examine the factors associated with cumulative HRT use. The duration of HRT use was analyzed by Kaplan-Meier curves. RESULTS A total of 1826 patients, including 352 (19.3%) who underwent primary surgery and 1474 (80.7%) who received primary radiotherapy, were identified. Overall, 39.0% of patients received HRT within 24 months of primary treatment. HRT was used in 49.4% of those who underwent primary surgery and in 36.6% of those who received primary radiotherapy (p<0.0001). The median duration of HRT use was 60 days among the entire cohort and was significantly shorter for the primary radiotherapy group than the primary surgery group (35 vs 90 days, p<0.0001). Primary radiotherapy, older age, residency in the Northeastern USA, and Black race were associated with a lower likelihood of HRT use. CONCLUSIONS HRT was prescribed to less than half of patients with newly diagnosed cervical cancer under the age of 50 who experienced premature menopause due to primary treatment. Among those who used HRT the duration of use was short.
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Affiliation(s)
- Yukio Suzuki
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Yongmei Huang
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Jennifer Ferris
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Amita Kulkarni
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Dawn Hershman
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Jason D Wright
- Obstetrics and Gynecology, Columbia University, New York, New York, USA
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15
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Donohoe F, O’Meara Y, Roberts A, Comerford L, Kelly CM, Walshe JM, Lundy D, Hickey M, Brennan DJ. Using menopausal hormone therapy after a cancer diagnosis in Ireland. Ir J Med Sci 2023; 192:45-55. [PMID: 35141870 PMCID: PMC9892117 DOI: 10.1007/s11845-022-02947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Menopause may cause a constellation of symptoms that affect quality of life. Many women will have menopause induced or exacerbated by treatment for cancer whether that be through surgery, chemotherapy, radiotherapy, or anti-endocrine therapy. As treatments advance, the number of people living with and beyond a cancer diagnosis is set to increase over the coming years meaning more people will be dealing with the after effects of cancer and its treatment. AIMS This review aims to summarise available data to guide clinicians treating women with menopausal symptoms after the common cancer diagnoses encountered in Ireland. The use of menopausal hormone therapy is discussed as well as non-hormonal and non-pharmacological options. CONCLUSIONS Managing menopausal symptoms is an important consideration for all physicians involved in the care of people living with and beyond a cancer diagnosis. High-quality data may not be available to guide treatment decisions, and, thus, it is essential to take into account the impact of the symptoms on quality of life as well as the likelihood of recurrence in each individual case.
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Affiliation(s)
- Fionán Donohoe
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Yvonne O’Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Aidin Roberts
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Louise Comerford
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine M. Kelly
- Dept. of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Janice M. Walshe
- Dept. of Medical Oncology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - Deirdre Lundy
- Reproductive and Sexual Health Co-Ordinator, Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Melbourne, VIC Australia
| | - Donal J. Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland ,UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
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16
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Li FG, Nesbitt-Hawes E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women-Reply. JAMA 2022; 327:284-285. [PMID: 35040889 DOI: 10.1001/jama.2021.22308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fiona G Li
- School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Jason A Abbott
- School of Women's and Children's Health, Sydney, New South Wales, Australia
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17
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Gold EB, Crawford SL, Leung K, Greendale G, Reeves KW, Joffe H, Avis NE. Vasomotor symptoms in midlife women with incident breast cancer: pink SWAN. Breast Cancer Res Treat 2022; 191:125-135. [PMID: 34694536 PMCID: PMC8758653 DOI: 10.1007/s10549-021-06425-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/14/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE We compared trajectories of vasomotor symptoms (VMS) and their risk factors in women with breast cancer (BrCa) to those of cancer-free controls. METHODS Data were from 15 nearly annual follow-up visits (1996-2017) of the multi-racial/ethnic cohort of midlife women enrolled in the Study of Women's Health Across the Nation (SWAN). We compared women with incident BrCa to controls for patterns of VMS, controlling for risk factors identified in bivariate analyses using multivariable longitudinal analyses. RESULTS Characteristics at study entry largely did not differ between cases (n = 151) and controls (n = 2161). Adjusted prevalence of any VMS increased significantly among cases from diagnosis to 2.75 years post diagnosis [per-year adjusted odds ratio (aOR) = 1.76, 95% confidence interval (CI) 1.39-2.24], peaking at 2.75 years post diagnosis, whereas prevalence was stable among controls in this interval [aOR = 1.04, 95% CI 0.99-1.11]. Beyond 2.75 years post diagnosis, prevalence declined significantly in cases [aOR = 0.72, 95% CI 0.61-0.84] and less in controls [aOR = 0.96, 95% CI 0.92-1.00]. Patterns were similar for frequent VMS. Adjustment for tamoxifen use slightly reduced the per-year OR for any prevalent VMS post diagnosis, partially explaining excess VMS in cases. Other treatments were unassociated with VMS. CONCLUSIONS Patterns of prevalent VMS reporting differed significantly between cases and controls, particularly post diagnosis, the latter only partially explained by tamoxifen use among cases. Risk factors for VMS largely did not differ between cases and controls.
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Affiliation(s)
- Ellen B Gold
- University of California Davis School of Medicine, Davis, USA.
- Department of Public Health Sciences, University of California Davis, One Shields Ave., Med Sci 1C, Davis, CA, 95616, USA.
| | | | | | - Gail Greendale
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Katherine W Reeves
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, USA
| | - Hadine Joffe
- Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Nancy E Avis
- Wake Forest University School of Medicine, Winston-Salem, USA
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18
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Donohoe F, O'Meara Y, Roberts A, Comerford L, Kelly CM, Walshe JM, Peate M, Hickey M, Brennan DJ. The menopause after cancer study (MACS) - A multimodal technology assisted intervention for the management of menopausal symptoms after cancer - Trial protocol of a phase II study. Contemp Clin Trials Commun 2021; 24:100865. [PMID: 34869938 PMCID: PMC8626829 DOI: 10.1016/j.conctc.2021.100865] [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: 03/31/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Aims This study will aim to assess if a composite intervention which involves a specific evidence-based intervention for management of insomnia and non-hormonal pharmacotherapy to manage vasomotor symptoms (VMS) of menopause can improve quality of life for patients experiencing troublesome VMS after cancer who are not eligible for standard systemic menopausal hormone therapy (MHT). Participants will be asked to nominate a partner or companion to support them during this process as an additional form of support. Background The menopause transition and its symptoms represent a significant challenge for many patients after cancer treatment, particularly those for whom conventional MHT is contraindicated. These symptoms include hot flushes, night sweats, urogenital symptoms as well as mood and sleep disturbance. These symptoms can exacerbate the consequences of cancer and its treatment. Methods We will recruit 205 women who meet inclusion criteria and enrol them on a composite intervention which consists of four parts: (1) use of non-hormonal pharmacotherapy for the management of troublesome vasomotor symptoms of menopause tailored to the timing of predominant symptoms, (2) digital cognitive behavioural therapy for insomnia through the web based Sleepio service, (3) access to information regarding self-management strategies for the common symptoms of menopause and their consequences and (4) identification of a partner or other support person who commits to providing support during the study period. Outcomes The primary outcome will be cancer specific quality of life measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30). Secondary outcomes will include sleep quality, bother/interference of vasomotor symptoms and communication between couples about their cancer diagnosis and their menopause experience. Sleep will be measured using the Sleep Condition Indicator (SCI) tool, bother/interference of vasomotor symptoms will be measured by the Hot Flush Rating Scale (HFRS) and communication will be measured using the Couples’ Illness Communication Scale (CICS). These validated scales will be administered at baseline, four weeks, three months and six months. Registration This study is registered on ClinicalTrials.gov with number NCT 04766229.
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Affiliation(s)
- Fionán Donohoe
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Yvonne O'Meara
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Aidin Roberts
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Louise Comerford
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine M Kelly
- Dept. of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Janice M Walshe
- Dept. of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michelle Peate
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia
| | - Donal J Brennan
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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19
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The use of menopausal hormone therapy after cancer. Best Pract Res Clin Obstet Gynaecol 2021; 81:22-30. [PMID: 34920970 DOI: 10.1016/j.bpobgyn.2021.11.005] [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: 09/26/2021] [Revised: 10/18/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022]
Abstract
The changing landscape of gynaecological and breast cancers has involved the development of more targeted and effective therapies, and improved survival. Ultimately, these changes result in an increasing number of women surviving their cancer diagnosis, with increasing emphasis on quality-of-life issues by following treatments. Many of these women experience severe menopausal symptoms associated with cancer treatments, but the hormonal nature of many gynaecological and breast cancers complicates the effective management of these symptoms. Generally, there is a paucity of high-quality data directly examining the safety of menopausal hormone therapy (MHT) following many female cancers, and more research is needed with long term follow-up to ensure the provision of comprehensive, patient-focussed care. This article aims to synthesise and evaluate the current evidence to provide comprehensive yet accessible information to clinicians to help guide treatment decisions about the use of MHT in women, who have experienced, or are at increased risk of, both gynaecological and breast cancers. These treatment decisions should often be made in a multi-disciplinary setting which encourages shared decision-making with patients.
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20
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Hollingworth J, Walsh L, Tran S, Ramage L, Patel-Brown S, Ambekar M, Weeks J, Williams L, Cohen PA. Does a multidisciplinary menopausal symptoms after cancer clinic reduce symptoms? Support Care Cancer 2021; 30:2245-2252. [PMID: 34714415 DOI: 10.1007/s00520-021-06637-4] [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: 05/30/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to measure the prevalence of menopausal symptoms in patients attending a multidisciplinary model of care clinic at their initial clinic visit and their subsequent follow-up consultation using a validated patient-reported outcome measure to assess whether menopausal symptoms after cancer had improved. METHODS A retrospective review was conducted of patients attending the clinic in a 12-month period in 2017 (n = 189). Recorded variables included patient demographics, details of index cancer, previous treatments, and menopausal symptom management strategies. Severity of menopausal symptoms was evaluated using the Greene Climacteric Scale. The extent to which patients were bothered by symptoms was combined into two categories and dichotomized (present/absent). Differences in symptom prevalence between the initial consultation and first follow-up visit were examined using McNemar's test. RESULTS The majority of patients attending the clinic had a history of breast cancer (72%). Fifty-five percent of patients were prescribed a non-hormonal therapy at their initial visit, most commonly gabapentin. Significantly fewer patients reported being bothered by hot flushes, fatigue, sleep difficulties, and loss of interest in sex, anxiety, or troubles concentrating at the first follow-up visit compared to their initial consultation (p < 0.01). CONCLUSION In this study, there was an improvement in self-reported menopausal symptoms in a significant proportion of cancer survivors attending a multidisciplinary menopause clinic between their initial and first subsequent follow-up consultations.
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Affiliation(s)
| | - Lucy Walsh
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia
| | - Stephanie Tran
- University of Western Australia, Crawley, WA, 6009, Australia
| | - Lesley Ramage
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia
| | | | - Manju Ambekar
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia
| | - Jane Weeks
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia
| | - Lucy Williams
- King Edward Memorial Hospital, Subiaco, WA, 6008, Australia
| | - Paul A Cohen
- University of Western Australia, Crawley, WA, 6009, Australia.,St John of God Hospital, Subiaco, WA, 6008, Australia
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21
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Lensen S, Archer D, Bell RJ, Carpenter JS, Christmas M, Davis SR, Giblin K, Goldstein SR, Hillard T, Hunter MS, Iliodromiti S, Jaisamrarn U, Joffe H, Khandelwal S, Kiesel L, Kim BV, Lambalk CB, Lumsden MA, Maki PM, Nappi RE, Panay N, Roberts H, Shifren J, Simon JA, Vincent A, Wolfman W, Hickey M. A core outcome set for vasomotor symptoms associated with menopause: the COMMA (Core Outcomes in Menopause) global initiative. Menopause 2021; 28:852-858. [PMID: 33906204 DOI: 10.1097/gme.0000000000001787] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Vasomotor symptoms (VMS) (hot flashes and night sweats) affect most women over the menopause transition. Comparing the safety and effectiveness of treatments for vasomotor symptoms is limited by the use of inconsistent outcome measures, and uncertainty as to which outcomes are most important to symptomatic women. To address this, we have developed a Core Outcome Set (COS) for use in clinical trials of treatments for VMS. METHODS We systematically reviewed the primary outcomes measured in randomized controlled trials of treatments for VMS. These were refined and entered into a two-round modified Delphi survey completed by clinicians, researchers, and postmenopausal women between November 2019 and March 2020. Outcomes were scored on a nine-point scale from "not important" to "critically important." Two international consensus meetings were held to finalize the COS. RESULTS Based on the systematic review, 13 separate outcomes were included in the Delphi process. This was completed by 227 participants of whom 58% were postmenopausal women, 34% clinicians, and 8% researchers. Predefined thresholds were applied to categorize importance scores obtained during Round 2 of the Delphi survey. These informed discussions at the consensus meetings which were attended by 56 participants from 28 countries. The final COS includes six outcomes: 1) frequency of VMS, 2) severity of VMS, 3) distress, bother or interference caused by VMS, 4) impact on sleep, 5) satisfaction with treatment, and 6) side-effects of treatment. CONCLUSION Implementation of this COS will: better enable research studies to accurately reflect the joint priorities of postmenopausal women, clinicians and researchers, standardize outcome reporting, and facilitate combining and comparing results from different studies, and ultimately improve outcomes for women with bothersome VMS.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - David Archer
- Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karen Giblin
- Red Hot Mamas North America, Inc, Town of Ridgefield, CT
| | - Steven R Goldstein
- Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University London, London, UK
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Bobae V Kim
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Cornelis B Lambalk
- Amsterdam Reproduction and Development, Center for Reproductive Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mary Ann Lumsden
- Department of Reproductive and Maternal medicine, School of Medicine, University of Glasgow, Glasgow, UK
| | - Pauline M Maki
- University of Illinois at Chicago, Departments of Psychiatry, Psychology and Obstetrics and Gynecology, Chicago, IL
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's and Chelsea and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Amanda Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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22
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Brennan A, Hickey M. Management of Early Menopause/Premature Ovarian Insufficiency in Women with or at High Risk of Breast Cancer. Semin Reprod Med 2021; 38:309-314. [PMID: 33791998 DOI: 10.1055/s-0041-1726467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The global incidence of breast cancer is increasing, as is the efficacy of treatments. Consequently, increasing survival rates reinforce the importance of survivorship issues, including posttreatment menopausal symptoms, sexual function, and mental health and well-being. Breast cancer patients can experience a range of menopausal symptoms associated with their treatment. Most commonly women may experience vasomotor symptoms, including hot flushes and night sweats. Particularly for women on maintenance tamoxifen therapy, up to 80% will experience hot flushes, with almost one-third of these women reporting severe symptoms. Breast cancer patients may also experience genitourinary symptoms of menopause, which may include vaginal dryness and irritation, dyspareunia, and dysuria. Hormonal therapy has long been established as the most effective treatment for vasomotor symptoms. However, the hormonal nature of breast malignancies renders systemic hormone therapies unsuitable for these patients, posing a unique treatment challenge, which may result in clinicians not feeling confident to manage them. Consequently, this review outlines pharmacological and nonpharmacological options for women with bothersome menopausal symptoms after breast cancer treatment and provides practical, evidence-based guidance for clinicians.
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Affiliation(s)
| | - Martha Hickey
- Royal Women's Hospital, Parkville, Victoria Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
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Peate M, Saunders C, Cohen P, Hickey M. Who is managing menopausal symptoms, sexual problems, mood and sleep disturbance after breast cancer and is it working? Findings from a large community-based survey of breast cancer survivors. Breast Cancer Res Treat 2021; 187:427-435. [PMID: 33575860 DOI: 10.1007/s10549-021-06117-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine the nature and severity of vasomotor symptoms, sexual problems, mood and sleep disturbance in community-dwelling breast cancer patients, whether and where they received treatment for these symptoms and their satisfaction with treatment received. METHODS Online cross-sectional survey distributed through Breast Cancer Network Australia (BCNA). RESULTS 524/2286 women responded to the invitation to participate. Of these, 74% (385/523) reported symptoms of interest and were included in the analysis. Mean age was 55.2 years and mean time since breast cancer diagnosis was 5.7 years. Most (66%) had received chemotherapy and were taking endocrine therapy (64%). The most common symptoms were hot flushes/night sweats and sleep disturbance (both 89%), vaginal dryness (75%), mood swings (62%) and sexual problems (60%). Symptoms were mild (21-33%) or moderate (21-38%) in around one third and severe in up to one quarter (8-26%). Symptoms affected the ability to "get on with their life" for 36%, predicted by severity of hot flushes (OR 1.4), sleep disturbance (OR 1.3), mood disturbance (OR 1.3), and sexual problems (OR 1.3). Only 32% were offered treatment, mostly delivered by GPs (33%) or oncologists (26%). Only 49% found this "somewhat effective" and 34% found it ineffective. The majority (60%) wanted more support to manage their symptoms. CONCLUSION Menopausal symptoms, sexual problems, mood and sleep difficulties are common after breast cancer and often not effectively managed. There is an unmet need for coordinated care providing effective treatments.
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Affiliation(s)
- Michelle Peate
- Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Christobel Saunders
- Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia School of Surgery, Murdoch, WA, 6150, Australia
| | - Paul Cohen
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, 6009, Australia
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia
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Brennan A, Brennan D, Rees M, Hickey M. Management of menopausal symptoms and ovarian function preservation in women with gynecological cancer. Int J Gynecol Cancer 2020; 31:352-359. [PMID: 33127864 DOI: 10.1136/ijgc-2020-002032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Gynecological cancers affect a growing number of women globally, with approximately 1.3 million women diagnosed in 2018. Menopausal symptoms are a significant health concern after treatment for gynecological cancers and may result from oncologic treatments such as premenopausal bilateral oophorectomy, ovarian failure associated with chemotherapy or radiotherapy, and anti-estrogenic effects of maintenance endocrine therapy. Additionally, with the growing availability of testing for pathogenic gene variants such as BRCA1/2 and Lynch syndrome, there is an increasing number of women undergoing risk-reducing oophorectomy, which in most cases will be before age 45 years and will induce surgical menopause. Not all menopausal symptoms require treatment, but patients with cancer may experience more severe symptoms compared with women undergoing natural menopause. Moreover, there is increasing evidence of the long-term implications of early menopause, including bone loss, cognitive decline and increased cardiovascular risk. Systemic hormone therapy is well established as the most effective treatment for vasomotor symptoms and vaginal (topical) estrogen therapy is effective for genitourinary symptoms. However, the role of hormone receptors in many gynecological cancers and their treatment pose a challenge to the management of menopausal symptoms after cancer. Consequently, the use of menopausal hormone therapy in this setting can be difficult for clinicians to navigate and this article aims to provide current, comprehensive guidance for the use of menopausal hormone replacement therapy in women who have had, or are at risk of developing, gynecological cancer to assist with these treatment decisions.
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Affiliation(s)
| | - Donal Brennan
- Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Martha Hickey
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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25
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Ettridge K, Caruso J, Roder D, Prichard I, Scharling-Gamba K, Wright K, Miller C. A randomised online experimental study to compare responses to brief and extended surveys of health-related quality of life and psychosocial outcomes among women with breast cancer. Qual Life Res 2020; 30:407-423. [PMID: 32990882 DOI: 10.1007/s11136-020-02651-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Collecting patient-reported outcomes is important in informing the well-being of women with breast cancer. Consumer perceptions are important for successful implementation of monitoring systems, but are rarely formally assessed. We compared reactions to two different surveys (assessing psychosocial outcomes and/or Health-related Quality of Life (HrQoL) outcomes) among Australian women with breast cancer. METHODS Women (18 + years) within 5 years diagnosis of breast cancer were randomly allocated to complete one of two online surveys: (i) minimum HrQoL measures or (ii) minimum HrQoL measures plus psychosocial outcomes (body image, depression, anxiety stress, fear of cancer recurrence, decisional difficulties and unmet need). Participants completed questions regarding their perceptions of the survey, including qualitative feedback. RESULTS Data were available for 171 participants (n(i) = 89; n(ii) = 82), with 92% (n = 158) providing 95-100% complete data. Perceptions were comparable between survey groups, and high (80-100%) regarding time burden, ease of completion, comprehensible, appropriateness and willingness to participate again and moderately high (67-74%) regarding willingness to answer more questions and relevance. Qualitative feedback indicated gaps across both surveys, including financial/work-related issues, satisfaction with information and care, need for nuanced questions, and impact of side effects/treatment, and from the minimum set only, emotional well-being and support. Impairment in some HrQoL and psychosocial outcomes were observed among participants. CONCLUSIONS Assessment of HrQoL and psychosocial outcomes was well received by consumers. Results alleviate concern regarding possible patient burden imposed by longer more in-depth surveys. The importance placed on assessment brevity should not outweigh the need to assess outcomes that consumers consider important.
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Affiliation(s)
- Kerry Ettridge
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia.
| | - Joanna Caruso
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
| | - David Roder
- University of South Australia, Adelaide, SA, Australia
| | - Ivanka Prichard
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Katrine Scharling-Gamba
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
| | - Kathleen Wright
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
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26
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McCormick CA, Brennan A, Hickey M. Managing vasomotor symptoms effectively without hormones. Climacteric 2020; 23:532-538. [DOI: 10.1080/13697137.2020.1789093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C. A. McCormick
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Parkville, VIC, Australia
| | - A. Brennan
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Parkville, VIC, Australia
| | - M. Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Parkville, VIC, Australia
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Shan D, Zou L, Liu X, Shen Y, Cai Y, Zhang J. Efficacy and safety of gabapentin and pregabalin in patients with vasomotor symptoms: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:564-579.e12. [PMID: 31870736 DOI: 10.1016/j.ajog.2019.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/10/2019] [Accepted: 12/14/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Vasomotor symptoms are common among postmenopausal women and patients receiving hormone deprivation therapies, and emerging studies are exploring gabapentin's and pregabalin's effects as nonhormonal treatment options. We aimed to assess the efficacy and safety of these 2 drugs. DATA SOURCES Based on a preregistered protocol (Prospective Register of Systematic Reviews -CRD42019133650), we searched 10 databases (PubMed, Embase, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Chinese Biological Medical Literature, Chinese National Knowledge Infrastructure, Chinese Journals Full-text Database [VIP], and Wanfang) as well as the World Health Organization international clinical trials registry platform and reference lists of related literatures. STUDY ELIGIBILITY CRITERIA Randomized controlled trials and randomized crossover studies exploring gabapentin and pregabalin among women patients with vasomotor symptoms were included. STUDY APPRAISAL AND SYNTHESIS METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement was followed. Two reviewers independently selected studies, assessed bias, and extracted data. Mean difference and standardized mean difference with 95% confidence intervals were assessed by random-effects models. Heterogeneities were assessed by I2 statistics, and the quality of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Nineteen randomized controlled trials and 2 randomized crossover trials reporting results from 3519 participants were included. Gabapentin could reduce hot flash frequency (mean difference, -1.62, 95% confidence interval, -1.98 to -1.26 after 4 weeks; mean difference, -2.77, 95% confidence interval, -4.29 to -1.24 after 12 weeks) and composite score (standardized mean difference, -0.47, 95% confidence interval, -0.71 to -0.23 after 4 weeks; standardized mean difference, -0.77, 95% confidence interval, -1.15 to -0.40 after 12 weeks) compared with placebo. Both menopausal participants and patients with breast cancer benefited from treatment. Higher risks of dizziness and somnolence were found in the gabapentin group than in the control group (risk ratio, 4.45, 95% confidence interval, 2.50-7.94; risk ratio, 3.29, 95% confidence interval, 1.97-5.48, respectively). Estrogen was more effective in reducing hot flash frequency than gabapentin. No statistically significant difference in reduction of hot flash severity score was found between gabapentin and antidepressants. The trials comparing gabapentin or pregabalin with the other interventions were too limited to make a conclusion. CONCLUSION Favorable effects of gabapentin in relieving vasomotor symptoms were observed, compared with controls, but were less effective than those of estrogen. Evidence supporting the therapeutic effect of pregabalin is still lacking.
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Liu J, Nie G, Li Y, Wen Z, Lu L, Xie L, Cao D, Lai Y, Yang H. Nonhormonal Hot Flash Management for Breast Cancer Survivors: A Systematic Review and Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:4243175. [PMID: 32419803 PMCID: PMC7204350 DOI: 10.1155/2020/4243175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
MATERIALS AND METHODS We conducted a systematic literature search in PubMed, Cochrane Central Register of Controlled Trials, Embase, Chinese Biomedicine Database (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP up to May 2018. Randomized controlled trials (RCTs) reporting nonhormonal hot flash treatments for breast cancer survivors were included. Primary outcome measurements were hot flash frequency and hot flash score of posttreatment. The methodological quality of each study was assessed with Cochrane's risk of bias tool. RESULTS 16 RCTs involving 2,349 participants were included. The nonhormonal therapies used in the included studies were classified as follows: lifestyle changes, mind-body techniques, dietary/supplements, SSRIs/SNRIs, other medications, and other therapies. Pairwise meta-analysis showed that the general effect of nonhormonal management was statistically more effective than no treatment/placebo/sham in reducing hot flash frequency (SMD = -0.60, 95% CI [-1.13, -0.06]; P=0.03)) and hot flash score (SMD = -0.38, 95% CI [-0.68, -0.08]). For hot flash frequency, results from the NMA showed that there was no statistically significant difference between any two of the nonhormonal treatments. Another NMA result indicated that acupuncture (other therapies) was 16.05 points more effective in reducing hot flash scores than no treatment/waitlist (SMD = -16.05, 95% CI [-30.2, -1.99]). These results were statistically significant. Acupuncture was also ranked the optimal nonhormonal therapy for both hot flash frequency and hot flash score. The safety analysis showed that there were few related adverse events during acupuncture and that drug related adverse reactions could have also occurred in studies using drug interventions. CONCLUSIONS This network meta-analysis comparing nonhormonal treatments suggested that acupuncture might be more effective in improving hot flashes for breast cancer survivors. A pronounced placebo response was found during hot flash treatments. The evidence of safety for nonhormonal therapies was also insufficient. Therefore, at present, we cannot make confirmative recommendations of nonhormonal hot flash management for breast cancer survivors. This study is registered with PROSPERO (CRD42018082008).
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Affiliation(s)
- Jian Liu
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Guangning Nie
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Yang Li
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China
| | - Zehuai Wen
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Liming Lu
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Li Xie
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Dongdong Cao
- Department of Chinese Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Yafang Lai
- Department of Gynecology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hongyan Yang
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Jain AL, Jamy O, Mullins J, Usman RM, Hare F, Valasareddy P, Chaudhry A, Ryder J, Smith JR, Miller E, Ranganath H, Schwartzberg L, Stepanski E, Walker M, Gatwood J, Vidal GA. Usefulness of patient-reported outcomes to assess the effectiveness of topical hormonal therapy for gynecologic symptoms after antihormonal treatment for breast cancer. Proc (Bayl Univ Med Cent) 2020; 33:331-335. [PMID: 32675948 DOI: 10.1080/08998280.2020.1744059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/24/2020] [Accepted: 03/06/2020] [Indexed: 02/08/2023] Open
Abstract
The aim of this retrospective study was to assess the efficacy of topical hormonal therapy (THT) to relieve vaginal symptoms resulting from antihormonal therapy in women with hormone receptor-positive breast cancer. A total of 74 breast cancer patients who received THT for vaginal complaints were retrospectively identified and statistically matched with 74 control breast cancer patients with vaginal complaints with no documented use of THT. Symptom scores were recorded from the center's proprietary patient-reported outcomes database, Patient Care Monitor (ConcertoHealthAI, Boston). A baseline score was noted at the initiation of antihormonal therapy and was followed at 6 and 12 months. The median differences between baseline, 6-month, and 12-month scores were analyzed. Repeated measures analysis of variance assessed the impact of topical hormonal replacement. There was no statistically significant difference in score change between the two groups at 6 and 12 months. In the active THT group, there were no statistically significant differences in vaginal complaints or sexual problems over time: {F (2, 146) = 0.99, P = 0.369; and F (2, 146) = 1.56, P = 0.217}, respectively. In this study, the use of topical hormonal replacement was not effective in alleviating vaginal symptoms.
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Affiliation(s)
- Amit L Jain
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee
| | - Omer Jamy
- Department of Hematology Oncology, University of Alabama Birmingham School of MedicineBirminghamAlabama
| | - Janice Mullins
- Medical Oncology, West Cancer Center and Research InstituteMemphisTennessee
| | - Rana Muhammad Usman
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee
| | - Felicia Hare
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee
| | - Poojitha Valasareddy
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee
| | - Amina Chaudhry
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee
| | - Julie Ryder
- Medical Oncology, West Cancer Center and Research InstituteMemphisTennessee
| | - Justin R Smith
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee
| | - Emily Miller
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee
| | - Harsha Ranganath
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee
| | - Lee Schwartzberg
- Medical Oncology, West Cancer Center and Research InstituteMemphisTennessee
| | | | | | - Justin Gatwood
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gregory A Vidal
- Department of Internal Medicine, Division of Hematology Oncology, University of Tennessee Health Sciences CenterMemphisTennessee.,Medical Oncology, West Cancer Center and Research InstituteMemphisTennessee
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Genetic predictors to acupuncture response for hot flashes: an exploratory study of breast cancer survivors. ACTA ACUST UNITED AC 2020; 27:913-917. [PMID: 32217888 DOI: 10.1097/gme.0000000000001545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Because hot flashes are a common symptom experienced by women with breast cancer, we sought to explore genetic predictors associated with response to acupuncture for the treatment of hot flashes. METHODS Using data from our completed randomized controlled trial (Clinicaltrials.gov identifier: NCT01005108) on hot flashes among breast cancer survivors who provided biomarker collection (N = 108), we extracted and assayed DNA for single nucleotide polymorphisms in genes involved in neurotransmission, thermoregulation, and inflammation (ADORA1, COMT, TCL1A, and TRPV1). For our primary outcome we classified individuals with a 50% or more reduction in their hot flash composite score at the end of treatment as responders. We used Fisher exact test to identify individual and combined single nucleotide polymorphisms associated with treatment response. RESULTS Among women (N = 57) who received acupuncture treatment (electro or sham), we found that women who were carriers of at least one of these six genotypes (ADORA1 rs41264025-GA or rs16851029-GG or rs12744240-GT, COMT rs6269-GA, TCL1A rs2369049-GG, and TRPV1 rs8065080-TT) were more likely to respond to acupuncture for hot flashes than noncarriers (70.3% vs 37.5%, P = 0.035). These six genotypes were not associated with response in women (N = 51) who received pharmacological hot flash treatment (gabapentin or placebo pill; 37.5% vs 37.5%, P = 1.0). CONCLUSIONS In this exploratory, proof of concept study, we identified six genotypes that may predict response to acupuncture for hot flashes in breast cancer survivors. If confirmed by future studies, these findings may inform the development of personalized acupuncture for managing hot flashes.
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Affiliation(s)
- R. A. Szabo
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, University of Melbourne, Melbourne, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Australia
| | - J. L. Marino
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - M. Hickey
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, University of Melbourne, Melbourne, Australia
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32
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Atema V, van Leeuwen M, Kieffer JM, Oldenburg HSA, van Beurden M, Gerritsma MA, Kuenen MA, Plaisier PW, Lopes Cardozo AMF, van Riet YEA, Heuff G, Rijna H, van der Meij S, Noorda EM, Timmers GJ, Vrouenraets BC, Bollen M, van der Veen H, Bijker N, Hunter MS, Aaronson NK. Efficacy of Internet-Based Cognitive Behavioral Therapy for Treatment-Induced Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial. J Clin Oncol 2019; 37:809-822. [PMID: 30763176 DOI: 10.1200/jco.18.00655] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We evaluated the effect of Internet-based cognitive behavioral therapy (iCBT), with or without therapist support, on the perceived impact of hot flushes and night sweats (HF/NS) and overall levels of menopausal symptoms (primary outcomes), sleep quality, HF/NS frequency, sexual functioning, psychological distress, and health-related quality of life in breast cancer survivors with treatment-induced menopausal symptoms. PATIENTS AND METHODS We randomly assigned 254 breast cancer survivors to a therapist-guided or a self-managed iCBT group or to a waiting list control group. The 6-week iCBT program included psycho-education, behavior monitoring, and cognitive restructuring. Questionnaires were administered at baseline and at 10 weeks and 24 weeks postrandomization. We used mixed-effects models to compare the intervention groups with the control group over time. Significance was set at P < .01. An effect size (ES) of .20 was considered small, .50 moderate and clinically significant, and .80 large. RESULTS Compared with the control group, the guided and self-managed iCBT groups reported a significant decrease in the perceived impact of HF/NS (ES, .63 and .56, respectively; both P < .001) and improvement in sleep quality (ES, .57 and .41; both P < .001). The guided group also reported significant improvement in overall levels of menopausal symptoms (ES, .33; P = .003), and NS frequency (ES, .64; P < .001). At longer-term follow-up (24 weeks), the effects remained significant, with a smaller ES for the guided group on perceived impact of HF/NS and sleep quality and for the self-managed group on overall levels of menopausal symptoms. Additional longer-term effects for both intervention groups were found for hot flush frequency. CONCLUSION iCBT, with or without therapist support, has clinically significant, salutary effects on the perceived impact and frequency of HF/NS, overall levels of menopausal symptoms, and sleep quality.
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Affiliation(s)
- Vera Atema
- 1 The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | - Gijsbert Heuff
- 5 Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
| | - Herman Rijna
- 6 Spaarne Gasthuis Haarlem, Haarlem, the Netherlands
| | | | | | | | | | - Matthé Bollen
- 11 Medical Centre Zuiderzee, Lelystad, the Netherlands
| | | | - Nina Bijker
- 13 Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Neil K Aaronson
- 1 The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Oliva A, García-Cebrián JM, Calatayud EF, Serrano-García I, Herraiz MA, Coronado PJ. A comparison of quality of life and resilience in menopausal women with and without a history of gynaecological cancer. Maturitas 2018; 120:35-39. [PMID: 30583762 DOI: 10.1016/j.maturitas.2018.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/31/2018] [Accepted: 11/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Resilience is a dynamic process that implies positive adaptation to adversity, and it is tested in stressful situations. In this study we compared resilience and menopause-related quality of life in women with and without a history of gynaecological cancer. METHODS A cross-sectional study was conducted with a total of 293 participants, all of them menopausal women: 80 cancer survivors and 213 without a history of cancer. Participants completed the 14-item Wagnild and Young Resilience Scale (WYRS-14) and the 16-item short form Cervantes (Cervantes-SF-16) questionnaire (on which a lower score indicates a higher menopause-related quality of life), and sociodemographic data were collected. RESULTS Resilience was significantly higher in the cancer survivors than in the menopausal women without a history of cancer: their total WYRS-14 scores were 86 points [72.25-90.00] and 80 points [69.80-88], respectively. Quality of life for cancer survivors was significantly worse than for women without a history of cancer: their total Cervantes-SF-16 scores were 45.01 [27.19-58.34] and 32.37 [20.00-44.80], respectively. Among the cancer survivors, women with a high resilience score had a better quality of life than those with a low resilience score: the groups' respective scores on the Cervantes-SF-16 total score were 35.98 [25.84-53.00] and 64.59 [51.81-76.68]. CONCLUSIONS A history of cancer significantly affected women's menopause-related quality of life. Cancer had an impact on resilience. Highly resilient menopausal women with a history of gynaecological cancer had a better menopause-related quality of life than less resilient women with a history of gynaecological cancer.
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Affiliation(s)
- Agustin Oliva
- Women's Health Institute of the Hospital Clínico San Carlos, Madrid, Spain.
| | | | | | - Irene Serrano-García
- Epidemiology and Health Service of the Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A Herraiz
- Women's Health Institute of the Hospital Clínico San Carlos, Madrid, Spain
| | - Pluvio J Coronado
- Women's Health Institute of the Hospital Clínico San Carlos, Madrid, Spain
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Phua C, Baber R. The Management of Menopausal Symptoms in Women Following Breast Cancer: An Overview. Drugs Aging 2018; 35:699-705. [PMID: 30073604 DOI: 10.1007/s40266-018-0574-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The improved detection and successful treatment of breast cancer, resulting in better survival rates, has led to an increasing number of women living with the effects of treatment modalities and their long-term consequences. Menopausal symptoms following breast cancer can occur at an earlier age, be more severe and significantly influence a woman's overall wellbeing, in particular, sexual function, quality of life and adherence to treatment. There is a dearth of good quality evidence on the safest and most effective treatment options available for these women, and this article aims to summarize the current available treatments. Pertinent to these women is general advice, such as avoidance of triggers, and lifestyle modifications. Following which, non-pharmacological interventions, including cognitive behavior therapy (CBT), hypnosis, acupuncture, stellate ganglion nerve block and complementary agents, are discussed. Pharmacological therapies and their safety profile in these high-risk women are then examined; namely, menopausal hormone therapy, progestogens, antidepressants (selective serotonin reuptake inhibitors and selective noradrenaline reuptake inhibitors), gabapentin, clonidine and intra-vaginal dehydroepiandrosterone (DHEA). Finally, neurokinin 3 receptor antagonists, promising new agents for the treatment of troublesome menopausal vasomotor symptoms, are discussed.
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Affiliation(s)
- Cheryl Phua
- Royal Prince Alfred Hospital, Sydney, Australia
| | - Rodney Baber
- Obstetrics and Gynaecology, Sydney Medical School North, Royal North Shore Hospital, The University of Sydney, Sydney, Australia.
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Efficacy of a biobehavioral intervention for hot flashes: a randomized controlled pilot study. Menopause 2018; 24:774-782. [PMID: 28266949 DOI: 10.1097/gme.0000000000000837] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The need for effective nonhormonal treatments for hot flash management without unwanted side effects continues. The primary aim of this pilot study was to evaluate the effect of combining a nonhormonal pharmacologic agent with a behavioral treatment for hot flash reduction. METHODS Seventy-one postmenopausal women were randomized to one of four groups: venlafaxine 75 mg + hypnosis (VH) versus venlafaxine 75 mg + sham hypnosis (VSH) versus a placebo pill + hypnosis (PH) versus placebo pill + sham hypnosis (PSH). Women recorded hot flash severity and frequency in a daily diary, in real time. The intrapatient difference in hot flash score (frequency × severity) at 8 weeks was analyzed using a General Estimating Equation model, using VSH as the referent arm, controlling for baseline hot flashes. RESULTS The active arms including PH or VH were not statistically significantly different than VSH (P = 0.34, P = 0.05, respectively). Women in each active arm reported hot flash reductions of about 50%, with the PSH group reporting a 25% reduction. Women receiving the PSH reported statistically significantly smaller reductions in hot flash score than women in the referent VSH arm (P = 0.001). There were no significant negative side effects during the course of the study. CONCLUSIONS Hypnosis alone reduced hot flashes equal to venlafaxine alone, but the combination of hypnosis and venlafaxine did not reduce hot flashes more than either treatment alone. More research is needed to clarify whether combining hypnosis with a different antidepressant would provide synergistic benefits.
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Marino JL, McNamara HC, Hickey M. Managing menopausal symptoms after cancer: an evidence‐based approach for primary care. Med J Aust 2018; 208:127-132. [DOI: 10.5694/mja17.00693] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/08/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Jennifer L Marino
- Royal Women's Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | | | - Martha Hickey
- Royal Women's Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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How does adjuvant chemotherapy affect menopausal symptoms, sexual function, and quality of life after breast cancer? Menopause 2018; 23:1000-8. [PMID: 27272225 DOI: 10.1097/gme.0000000000000664] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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 determine the association between adjuvant chemotherapy for breast cancer and menopausal symptoms, sexual function, and quality of life. METHODS Participants attended a menopause clinic with a dedicated service for cancer survivors at a large tertiary women's hospital. Information about breast cancer treatments including adjuvant chemotherapy was collected from medical records. Menopausal symptoms were recorded with the Greene Climacteric Scale and Functional Assessment of Cancer Therapy, Breast Cancer, and Endocrine Symptom Subscales. Sexual symptoms were recorded using Fallowfield's Sexual Activity Questionnaire. Quality of life was measured with Functional Assessment of Cancer Therapy scales. RESULTS The severity of vasomotor, psychological, or sexual symptoms (apart from pain) did not differ between those who had received adjuvant chemotherapy (n = 339) and other breast cancer survivors (n = 465). After adjustment for current age, time since menopause, and current use of antiestrogen endocrine therapy, the risk of "severe pain" with sexual intercourse was twice as common after chemotherapy (31.6% vs 20.0%, odds ratio [OR] 2.18, 95% CI 1.25-3.79). Those treated with chemotherapy were more likely to report "severe problems" with physical well-being (OR 1.92, 95% CI 1.12-3.28) and lower breast cancer-specific quality of life (OR 1.89 95% CI 1.13-3.18), but did not differ in other quality of life measures. CONCLUSIONS In this large study of breast cancer patients presenting to a specialty menopause clinic, previous chemotherapy was not associated with current vasomotor or psychological symptoms. Severe pain with intercourse was significantly more common in those treated with adjuvant chemotherapy.
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Late breast cancer treatment-related symptoms and functioning: associations with physical activity adoption and maintenance during a lifestyle intervention for rural survivors. Breast Cancer Res Treat 2017; 168:755-761. [PMID: 29273954 DOI: 10.1007/s10549-017-4603-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Physical activity may be difficult for survivors with poorer functioning following primary treatment. The study examined whether late symptoms of breast cancer treatment impact PA adoption (0-6 months) and maintenance (6-18 months) during a weight management intervention, and whether late symptoms influence PA when accounting for overall functioning. METHODS Secondary analyses were conducted using a sample of survivors participating in a weight management intervention and who provided valid weight and accelerometer data at baseline and 6 months (N = 176). The Breast Cancer Prevention Trial Symptom Checklist (BCPT) assessed late treatment-related symptoms. SF-12 Physical Component Scale (PCS) and Mental Component Scale (MCS) scores assessed functioning. RESULTS Change in bouted moderate to vigorous physical activity (MVPA) min/week from baseline to 6 months was not associated with BCPT scales (all p values > 0.05). When adding SF-12 scores to the model, change in bouted MVPA min/week was significantly associated with the PCS (p = 0.045). Change in MVPA min/week from 6 to 18 months was significantly associated with cognitive symptoms (p = 0.004), but not musculoskeletal or vasomotor symptoms (p values > 0.05). When adding 6-month SF-12 scores to the model, MVPA min/week was significantly associated with PCS (p = 0.001) and MCS (p = 0.028); however, BCPT cognitive problems score became non-significant (p > 0.05). CONCLUSIONS Poorer physical functioning was associated with lower PA adoption, and poorer mental and physical functioning was associated with lower maintenance of PA, while late symptoms generally were not. Interventionists should consider level of functioning when identifying individual PA goals during weight management interventions.
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Sexual inactivity in partnered female cancer survivors. Maturitas 2017; 105:89-94. [DOI: 10.1016/j.maturitas.2017.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 12/17/2022]
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Santen RJ, Stuenkel CA, Davis SR, Pinkerton JV, Gompel A, Lumsden MA. Managing Menopausal Symptoms and Associated Clinical Issues in Breast Cancer Survivors. J Clin Endocrinol Metab 2017; 102:3647-3661. [PMID: 28934376 DOI: 10.1210/jc.2017-01138] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Review evidence to guide management of menopausal signs and symptoms in women after breast cancer and make recommendations accordingly. EVIDENCE Randomized controlled clinical trials, observational studies, evidence-based guidelines, and expert opinion from professional societies. BACKGROUND Symptoms and clinical problems associated with estrogen depletion-sleep disorders, vulvovaginal atrophy (VVA), vasomotor symptoms (VMS), mood changes, depressive symptoms, cardiovascular disease, osteopenia, and osteoporosis-confront the estimated 9.3 million breast cancer survivors globally. RECOMMENDATIONS Following breast cancer, women should not generally be treated with menopausal hormone therapy or tibolone but should optimize lifestyle. Women with moderate to severe symptoms may benefit from mind-brain behavior or nonhormone, pharmacologic therapy. The selective serotonin/noradrenaline reuptake inhibitors and gabapentenoid agents improve VMS and quality of life. For osteoporosis, nonhormonal agents are available. Treatment of VVA remains an area of unmet need. Low-dose vaginal estrogen is absorbed in small amounts with blood levels remaining within the normal postmenopausal range but could potentially stimulate occult breast cancer cells, and although poorly studied, is not generally advised, particularly for those on aromatase inhibitors. Intravaginal dehydroepiandrosterone and oral ospemiphene have been approved to treat dyspareunia, but safety after breast cancer has not been established. Vaginal laser therapy is being used for VVA but efficacy from sham-controlled studies is lacking. Therapies undergoing development include lasofoxifene, neurokinin B inhibitors, stellate ganglion blockade, vaginal testosterone, and estetrol. CONCLUSIONS Nonhormone options and therapies are available for treatment of estrogen depletion symptoms and clinical problems after a diagnosis of breast cancer. Individualization of treatment is essential.
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Affiliation(s)
- Richard J Santen
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia 22903
| | - Cynthia A Stuenkel
- Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, California 92093
| | - Susan R Davis
- School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia
| | - JoAnn V Pinkerton
- Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, Virginia 22903
| | - Anne Gompel
- Hopitaux Universitaires Port Royal-Cochin Unite de Gynecologie Endocrinienne, Paris Descartes University, Paris 75014, France
| | - Mary Ann Lumsden
- Department of Medicine, Dentistry and Nursing, University of Glasgow School of Medicine, Glasgow G31 2ER, Scotland
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Moon Z, Hunter MS, Moss-Morris R, Hughes LD. Factors related to the experience of menopausal symptoms in women prescribed tamoxifen. J Psychosom Obstet Gynaecol 2017; 38:226-235. [PMID: 27583832 PMCID: PMC5556753 DOI: 10.1080/0167482x.2016.1216963] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Menopausal symptoms are frequent and severe in breast cancer survivors taking tamoxifen; however, treatment options are limited for these patients as hormonal replacement therapy is contraindicated. This study aimed to explore the experience and attribution of menopausal symptoms and identify factors related to the experience of menopausal symptoms in women taking tamoxifen. METHODS Women who had been prescribed tamoxifen for a diagnosis of primary breast cancer were recruited from oncology clinics across England and from online advertisements. Seven hundred and forty women completed questionnaires assessing illness perceptions, social support, mood and symptom duration/severity. RESULTS Eighty-four percent of women had experienced hot flushes and 80% experienced night sweats; of these, 60% experienced severe symptoms. Symptoms persisted throughout 5 years of treatment and were mainly attributed to tamoxifen. Logistic regressions showed that depressive symptoms, previous chemotherapy and being employed were associated with increased odds of hot flush or night sweat prevalence. Symptom severity was associated with depression, being employed and attributing symptoms to tamoxifen. DISCUSSION These findings have clinical implications in terms of targeting women who are more at risk and offering non-hormonal treatment options, such as cognitive behavioural therapy, to help women to develop self-management strategies for coping with menopausal symptoms.
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Affiliation(s)
- Zoe Moon
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Myra S. Hunter
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Lyndsay Dawn Hughes
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
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The prevalence of unmet needs in 625 women living beyond a diagnosis of early breast cancer. Br J Cancer 2017; 117:1113-1120. [PMID: 28859057 PMCID: PMC5674103 DOI: 10.1038/bjc.2017.283] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/18/2017] [Accepted: 07/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background: There are over half a million women with a previous breast cancer diagnosis living in the UK. It is important to establish their level of unmet physical and psychosocial needs, as many are not routinely seen for follow-up under current models of care. Methods: We conducted a retrospective analysis of early breast cancer survivors entering an Open Access Follow-Up (OAFU) programme in 2015. Unmet needs were assessed using the Holistic Needs Assessment (HNA) or extracted directly from the electronic patient record (EPR), when the HNA had not been completed. Results: Six hundred and twenty-five patients were eligible. Sixty-one per cent of the survivors had at least one unmet need and 18% had ⩾5 needs. Consistently higher levels of unmet needs were identified using the formal HNA checklist as opposed to extraction from EPR (P<0.001). Physical and emotional needs were the most frequently reported (55 and 24% respectively). Patients receiving endocrine therapy and those who had received chemotherapy were more likely to report unmet needs (both P<0.001). Conclusions: Unmet physical and emotional needs are common in breast cancer survivors. It is vital that the services are available for these patients as they transition from hospital-based follow-up to patient-led self-management models of care.
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Menopausal symptom clusters and their correlates in women with and without a history of breast cancer: a pooled data analysis from the Women's Wellness Research Program. Menopause 2017; 24:624-634. [DOI: 10.1097/gme.0000000000000810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Cohen PA, Brennan A, Marino JL, Saunders CM, Hickey M. Managing menopausal symptoms after breast cancer - A multidisciplinary approach. Maturitas 2017; 105:4-7. [PMID: 28473176 DOI: 10.1016/j.maturitas.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 01/01/2023]
Abstract
More than 6 million women worldwide are living with a past diagnosis of breast cancer. Most survive their illness, and management of the long-term consequences of treatment has become a priority in cancer care. Menopausal symptoms affect most breast cancer survivors and may significantly impair quality of life. We describe a multidisciplinary model to evaluate and manage these women using a patient-focused approach. The 'Multidisciplinary Menopause After Cancer Clinic' includes gynecologists, endocrinologists, GPs, a psychologist and a clinical nurse specialist. Benefits of this model include improved coordination of patient care, education, communication and evidence-based decision making.
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Affiliation(s)
- Paul A Cohen
- St. John of God Hospital Bendat Family Comprehensive Cancer Centre, 12 Salvado Road, Subiaco, Western Australia 6008, Australia; School of Women's and Infants' Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Institute for Health Research, University of Notre Dame Australia, 32 Mouat Street Fremantle, Western Australia 6160, Australia.
| | - Annabelle Brennan
- Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynecology, The University of Melbourne, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - Christobel M Saunders
- Division of Surgery, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynecology, The University of Melbourne, Parkville, Victoria 3052, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
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Fallowfield L, Solis-Trapala I, Menon U, Langridge C, May S, Jacobs I, Jenkins V. The effect of ovarian cancer screening on sexual activity and functioning: results from the UK collaborative trial of ovarian cancer screening RCT. Br J Cancer 2017; 116:1111-1117. [PMID: 28324886 PMCID: PMC5396121 DOI: 10.1038/bjc.2017.72] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/01/2017] [Accepted: 02/22/2017] [Indexed: 01/27/2023] Open
Abstract
Background: To examine the impact of multimodal (MMS) and ultrasound (USS) screening on the sexual activity and functioning of 22 966 women in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) RCT. Methods: Fallowfield's Sexual Activity Questionnaire (FSAQ) was completed prior to randomisation, then annually in a random sample (RS) of women from MMS, USS and control groups. Any women in the study who required repeat screening due to unsatisfactory results formed an Events Sample (ES); they completed questionnaires following an event and annually thereafter. Results: Over time in the RS (n=1339) there was no difference between the MMS and USS groups in sexual activity compared with controls. In the ES there were significant differences between the USS group (n=10 156) and the MMS group (n=12 810). The USS group had lower pleasure scores (mean difference=−0.14, P=0.046). For both groups women who had ⩾2 repeat screens, showed a decrease in mean pleasure scores compared with their annual scores (mean difference=−0.16, P=0.005). Similarly mean pleasure scores decreased following more intensive screens compared with annual screening (mean difference=−0.09, P=0.046). Conclusions: Ovarian cancer screening did not affect sexual activity and functioning unless a woman had abnormal results and underwent repeated or higher level screening.
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Affiliation(s)
- Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RX, UK
| | - Ivonne Solis-Trapala
- Institute for Applied Clinical Sciences, Guy Hilton Research Centre, Keele University, Newcastle ST4 7QB, UK
| | - Usha Menon
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK
| | - Carolyn Langridge
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RX, UK
| | - Shirley May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RX, UK
| | - Ian Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK.,University of New South Wales, Sydney, NSW 2052, Australia
| | - Valerie Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9RX, UK
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Balneaves LG, Panagiotoglou D, Brazier ASA, Lambert LK, Porcino A, Forbes M, Van Patten C, Truant TLO, Seely D, Stacey D. Qualitative assessment of information and decision support needs for managing menopausal symptoms after breast cancer. Support Care Cancer 2016; 24:4567-75. [PMID: 27278271 PMCID: PMC5031723 DOI: 10.1007/s00520-016-3296-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/30/2016] [Indexed: 11/05/2022]
Abstract
PURPOSE For breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors' CT and general information and decision-making needs related to menopausal symptoms. METHODS The needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n = 22) and interviews with conventional (n = 12) and CT (n = 5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data. RESULTS Menopausal symptoms have significant negative impact on BrCa survivors. Close to 70 % of the sample were currently using CTs, including mind-body therapies (45.5 %), natural health products (NHPs) and dietary therapies (31.8 %), and lifestyle interventions (36.4 %). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management. CONCLUSIONS High quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment.
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Affiliation(s)
- Lynda G Balneaves
- Centre for Integrative Medicine, Leslie Dan Faculty of Pharmacy, 144 College St., Room 737, Toronto, ON, M5S 3M2, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Dimitra Panagiotoglou
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison S A Brazier
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leah K Lambert
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Antony Porcino
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Cheri Van Patten
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tracy L O Truant
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dugald Seely
- Ottawa Integrative Cancer Centre, Ottawa, Ontario, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
PURPOSE OF REVIEW Young women (<45 years of age) diagnosed with breast cancer face increased risk of sexual dysfunction as a result of their cancer-directed treatment. We will review the recent literature examining this critical challenge and discuss current efforts to address sexual dysfunction. RECENT FINDINGS In the period since 2013, the literature has focused on sexual issues that result from the premature onset of menopausal symptoms and changes in sexual health following breast surgery. The impact of premature menopause in young women with breast cancer is profound and can affect all aspects of the sexual experience, from desire to function, and quality of life. Furthermore, the surgical treatment of breast cancer also has significant implications with respect to sexual desire and body image. There is a paucity of sexual health intervention for this population, though recent efforts suggest that sexual health outcomes may be improved if women are offered the appropriate intervention opportunities. However, the sexual function of young breast cancer patients is an under-discussed and under-treated health issue that warrants greater research and clinical focus. SUMMARY Further intervention trials must be completed in this population of young women for whom sexual function plays such a critical role in their personal and relationship well being.
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Johns C, Seav SM, Dominick SA, Gorman JR, Li H, Natarajan L, Mao JJ, Irene Su H. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions. Breast Cancer Res Treat 2016; 156:415-426. [PMID: 27015968 PMCID: PMC4838539 DOI: 10.1007/s10549-016-3765-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 03/21/2016] [Indexed: 01/06/2023]
Abstract
Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions.
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Affiliation(s)
- Claire Johns
- School of Medicine, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA, 94143-0401, USA
| | - Susan M Seav
- School of Medicine, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA
| | - Sally A Dominick
- Department of Reproductive Medicine, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA
| | - Jessica R Gorman
- College of Public Health and Human Sciences, Oregon State University, 2250 SW Jefferson Way, Corvallis, OR, 97331-6406, USA
| | - Hongying Li
- Department of Biostatistics, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA
| | - Loki Natarajan
- Department of Family Medicine & Public Health, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA
| | - Jun James Mao
- The Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, New York City, NY, 10021, USA
| | - H Irene Su
- Department of Reproductive Medicine, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive #0901, La Jolla, CA, 92093-0901, USA.
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Shapiro CL, Jacobsen PB, Henderson T, Hurria A, Nekhlyudov L, Ng A, Surbone A, Mayer DK, Rowland JH, Shapiro CL, Jacobsen PB, Henderson T, Hurria A, Nekhlyudov L, Ng A, Surbone A, Mayer DK, Rowland JH. ReCAP: ASCO Core Curriculum for Cancer Survivorship Education. J Oncol Pract 2016; 12:145, e108-17. [DOI: 10.1200/jop.2015.009449] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CONTEXT AND QUESTION(S) ASKED: The number of cancer survivors is increasing exponentially. Currently there about 15 million cancer survivors, and by 2025, there will be nearly 20 million. Who will provide survivorship care, what are evidenced-based or best care practices, what are best methods to disseminate this information and assess its impact on physician practice, and what are the most cost-effective health care delivery models to serve the majority of survivors? SUMMARY ANSWER: The ASCO Survivorship Committee in collaboration with the ASCO Professional Development Committee developed a core curriculum and core competencies for physicians, allied health professionals, training programs, and policymaking organizations. Adapted from Institute of Medicine recommendations for survivorship care, the core curriculum and competencies include the following subheadings: surveillance for recurrence and second malignancies, long-term and late effects, health promotion and prevention, psychosocial well-being, special populations including adolescent and young adult survivors, older adult cancer survivors, caregivers of cancer survivors and communication and care coordination. METHODS: An environmental scan (a process that systematically surveys and interprets relevant data to identify opportunities and barriers) for survivorship was performed. Although survivorship content exists in various courses, conferences, guidelines, and Web-based applications, the information is incomplete and not easily found. Hence, there was a need for this content to be easy to access and available in one place. Content experts formulated the individual sections based on the environmental scan and their knowledge of the various subheadings. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Both an environmental scan and a comprehensive literature review have standard methodologies. The differences are in scope; an environmental scan is more like an overview, and the standard literature review is more granular. For this article, we felt that environmental scan better served the purpose of developing a survivorship core curriculum and competencies. REAL-LIFE IMPLICATIONS: Survivorship care is one the most challenging problems oncologists face today and in the near future. Fundamental to the relatively new field of survivorship care is this core curriculum and competencies, which provide the framework necessary to generate appropriate referrals depending on local practices and expertise.
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Affiliation(s)
- Charles L. Shapiro
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Paul B. Jacobsen
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Tara Henderson
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Arti Hurria
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Larissa Nekhlyudov
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Andrea Ng
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Antonella Surbone
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Deborah K. Mayer
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Julia H. Rowland
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Charles L. Shapiro
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Paul B. Jacobsen
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Tara Henderson
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Arti Hurria
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Larissa Nekhlyudov
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Andrea Ng
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Antonella Surbone
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Deborah K. Mayer
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
| | - Julia H. Rowland
- Icahn School of Medicine at Mt Sinai; New York University School of Medicine, New York, NY; University of Tampa, Tampa, FL; University of Chicago, Chicago, IL; City of Hope, Duarte, CA; Harvard Vanguard Medical Associates; Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; and National Cancer Institute, Bethesda, MD
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